Healthcare Provider Details

I. General information

NPI: 1730471699
Provider Name (Legal Business Name): ILANA KATSNELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GELLERT BLVD STE 119
DALY CITY CA
94015-2690
US

IV. Provider business mailing address

333 GELLERT BLVD STE 119
DALY CITY CA
94015-2690
US

V. Phone/Fax

Practice location:
  • Phone: 415-361-6212
  • Fax: 415-480-8443
Mailing address:
  • Phone: 415-361-6212
  • Fax: 415-480-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56327
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA56327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: